US Model Of Healthcare Flashcards
Why is the government unable to agree on costs in US Healthcare Model
Because of lobbying power from different parties
What parts of US Healthcare Model come from the Bismarck Model
Insurance for individuals under 65
What parts of US Healthcare Model come from Beveridge Model
Government provision and insurance/payment to provide free healthcare to Native Americans, military veterans, and active military
What parts of US Healthcare Model come from National Health Insurance Model
Medicare for those over 65
What parts of the US Healthcare Model come from the Out-of-Pocket Model
Many uninsured or insured who are responsible for high healthcare costs
What is Medicare
Federal health insurance for anyone over 65 and those under 65 with disabilities or specific conditions
What conditions could qualify someone for Medicare
End stage renal disease, cancer, COPD, etc.
What was Medicare designed to do
To cover hospital services and doctors’ services but not it also covers drugs, most preventative services, or nursing home care
What is not covered by Medicare
Hearing aids and eyeglasses
How is Medicare funded
By payroll tax from employees and employers
What does Part A of Medicare cover
Hospital care, skilled nursing care, and home health care after hospitalization-hospice care
What does Part B of Medicare cover
Wide range of diagnostic and therapeutic services provided by physicians, emergency departments, and outpatient services
How does Part B of Medicare work
It is a voluntary supplementary insurance from private insurers where patients must pay 20% of copayments with a $150/year deductible
What is Part C of Medicare
A special program to encourage Medicare beneficiaries to enroll in prepaid health plans
What is Part D of Medicare
Prescription drug coverage plan (requires patients to pay monthly premiums and annual deductibles)
What % of GDP does the US spend on their healthcare per year
18% ($9000/person/year)
What is Medicaid
A joint federal/state program designed to pay for health services for people with limited income and resources, etc.
How does coverage for Medicaid work
It is comprehensive but physician reimbursement is relatively low (not every physician chooses to participate)
What kinds of physicians often choose not to participate in Medicaid
Mental health, dental, dermatology, etc.
How many people does Medicaid currently cover
75 million (half of who are children)
How is Medicaid financed
Jointly by federal governments and states
How is Medicaid administered
By states within broad federal guidelines
How much does the Federal government pay for Medicaid
Variable amount from 5%-83% depending on the state’s per capita income
What is the Federal poverty level for a family of four
$25,000
